Pleasant Valley Care Limited

Pleasant Valley Care is a domiciliary care agency providing the regulated activity of personal care to people living in their own homes. The service provides support to older people, people living with dementia and people with physical disabilities. At the time of our inspection there were 31 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person who was in receipt of the regulated activity of personal care. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Care

Care plans lacked guidance for staff on how to support people with specific health needs. Some relatives felt staff did not know enough about their health care needs to support them appropriately. A staffing crisis had led to some missed care calls. Relatives and people receiving care told us calls had since not been missed but were still often late. The service was providing care call ‘windows’ or broader time as agreed by the funding local authority. However, they had not ensured people who had a need for specific calls times were accommodated.

Right Care

People receiving care and their relatives shared mixed views on the support they received to eat and drink well. Some felt not all carers were good at preparing meals, others were happy with the support they received. Care plans provided guidance for staff on what people could and could not do for themselves. People were supported by staff who received a detailed induction and regular training.

Right Culture

People and relatives had mixed views about the management team. Some were unhappy with the level of consultation and communication; they told us they did not feel listened to. Some were happy with this aspect of the service and described the care manager as ‘lovely’. The provider’s quality assurance systems had not identified some of the concerns we found at inspection. In some cases, learning from mistakes made had not been sustained over time. However, the provider had made numerous changes to try to improve service delivery.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (Published 5 July 2019)

Why we inspected

We received concerns in relation to missed and late care calls. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider took action to address some of the concerns during the inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pleasant Valley Care Limited on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Pleasant Valley Care is a local area domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection the service supported 29 people.

People’s experience of using this service and what we found

The provider’s governance systems to check the quality of the service provided for people were not consistently effective and required some improvement.

People and relatives told us they felt the service was safe and there were sufficient numbers of staff that were safely recruited to support people. Staff had completed induction training that included safeguarding, medication, health and safety and moving and handling. Staff had access to equipment and clothing that protected people from cross infection.

People were protected from potential risk of harm; risk assessments were in place and staff knew how to support people’s individual needs to ensure they provided a consistent level of care. People’s care and support needs were assessed to ensure the service provided could meet their individual need.

Staff received ongoing training they required to meet people’s needs. People were supported to access healthcare services to ensure they received ongoing healthcare support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by kind and caring staff that knew them well. Staff encouraged people’s independence, protected their privacy and treated them with dignity.

People were supported by staff who knew their preferences. Complaints made since the last inspection had been investigated and resolved. People and their families knew who to contact if they had any complaints.

People and their relatives’ views were sought about the quality of the care being provided. Staff felt supported by the management team.

People, their relatives and staff were happy with the way the service was managed and the provider worked well with partner organisations to ensure people’s needs were met.

The service did not meet some of the characteristics of Good in one key question and more information is in the detailed findings below.

Rating at last inspection

The last rating for this service was requires improvement (published 16 June 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Pleasant Valley Care Limited is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection the service supported 35 people ranging in age, gender, ethnicity and disability.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we found the provider had not always reported notifiable incidents as required to do so by law. This was a breach of the Care Quality Commission (Registration) Regulations 2009.

Although the service had made sufficient improvement to meet the conditions of the breach identified at the last inspection; systems in place to assess and monitor the quality of the service provided to people were not always used effectively and required further improvement. Some care plans had not contained information to support staff and audits to identify or manage risks also required improvement.

Full information about CQC's regulatory response to issues and concerns found during inspections are added after any representations and appeals have been concluded.

Some people had experienced late and/or missed calls. We found there were still a number of occasions where calls were late and the time management of staff required further improvement. However, the provider had recently implemented an electronic call monitoring system which provided some assurance that calls would not be missed.

People felt safe in their homes with staff. Relatives believed their family members were kept safe. Staff understood the different types of abuse and knew what action they would take if they thought a person was at risk of harm. Risks to people were assessed and people were supported by staff that was provided with guidance on how to manage people’s specific medical conditions.

People were supported by sufficient numbers of staff that had been safely recruited. People were supported with their medication by staff that had received appropriate training. Staff members were equipped with sufficient personal protection equipment to reduce the risk of infection and cross contamination when supporting people with their personal care.

People’s needs were assessed to ensure the care and treatment provided was individual to the person. People were supported by staff that felt they had the skills and knowledge to care and support people in their homes. Where appropriate, people were supported by staff to access health and social care professionals.

People were supported to make choices and were involved in the care and support they received. The provider was taking the appropriate action to protect people’s rights.

People told us staff members were caring and treated them with dignity and respect. People’s choices and independence were respected and promoted and staff responded to people’s support needs. People were supported with their healthcare needs and felt involved with their care provision. People felt they could speak with the provider about their worries or concerns and felt they would be listened to and have their concerns addressed.

The provider gave people the opportunity to discuss and plan their preferences related to the care they wanted to receive at the end of their life.

Staff felt supported and spoke highly of the management team and felt involved in developing the service.

Pleasant Valley Care Limited was first registered August 2014 to provide personal care and support for adults in their own homes. At the time of our inspection the service provided care and support to 25 people.

At the last inspection the service did not have a registered manager in post. The service is required to have a registered manager in post. At this inspection there remains no registered manager in post. However, the provider was actively involved in the management of the business and was present throughout the site visit. The provider has recruited a care manager and it is intended to submit an application for the care manager to become the registered manager in January 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the last inspection, it was found there were insufficient numbers of staff working for the provider. People were not always protected from the risk of unsafe practice because risks associated with some medical conditions had not been appropriately assessed. The provider’s quality assurance and audit systems were not always effective because their processes did not identify action taken or what measures were put in place to recognise trends and prevent re-occurrences of events. We found at this inspection there had been some improvement but further improvement was required.

Systems in place to assess and monitor the quality of the service provided to people were not used effectively and required further improvement. Care plans had not been consistently reviewed; audits to identify or manage risks had not been consistently conducted. The procedures in place to ensure that potential new staff had background checks completed were not always robustly applied and also required improvement. You can see what action we have told the provider to take at the end of this report.

Most people had experienced late and some missed calls at short notice when unplanned staff absences occurred. There was some inconsistency with staff informing the office they were going to be late which made it difficult for the provider to inform people their calls would be late. Although the provider used an electronic call monitoring system which provided some assurance that calls would not be missed, we found staff did not consistently use the system and at least one missed call had not been identified. People told us it was important to them to see the same staff member(s) and they felt this had improved and that the provider tried to achieve this where possible.

People felt staff had the skills and knowledge to care and support them in their homes. The provider required new staff complete a two day induction training programme. New staff spent time shadowing an experienced staff member until they were deemed competent to work unsupervised. Staff explained they had completed their training although we found the provider had not maintained the staff training records to reflect completed training by staff and this required improvement.

Staff was caring and treated people with dignity and respect. People’s choices and independence was respected and promoted and staff responded to people’s support needs. People, relatives and staff felt they could speak with the provider about their worries or concerns and felt they would be listened to. Although there was a mixed opinion on the effectiveness of the action taken by the provider.

Risks to people had been assessed and staff were provided with the necessary guidance required to support people safely. People were included in the planning and review of their care; their care plans and risk assessments reflected their individual needs to ensure they received person-centred care. People felt safe and staff were aware of what would constitute abuse and knew how and who to report it to. The provider had processes and systems in place that kept people safe and protected them from the risk of abuse.

People were supported to make choices and were involved in the care and support they received. People's rights were protected because staff, including the provider understood their responsibilities related to the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. The provider knew what appropriate action should be taken to protect people’s legal rights.